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Please print or type,(Form dos pned for use on elite(12-pitch)typewriter:) Form AFpfovad.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS t Generalor ID Numbar 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A D S 8 1 9 6 7 6 8 0 1 (800)424-9300 1 017791724 J J K <br /> 5.Generator's Name and MotiingAddmss Generators Slla Address Of differan(than mailing addrr:ss) <br /> STOCKTON DODGE INC <br /> 3333 AUTO CENTER CIRCLE <br /> STOCKTON CA 95212 <br /> Cenerawr's Phone: 209 477-3668 <br /> L• rrwUp der I Company Narne U.S,EPA ID Nurrhar <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7,Transporter 2 Company Name US.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DEMENNO/KERDOON <br /> 2000 K.ALAMEDA STREET <br /> COMPTON CA 90222 CAT080013352 <br /> Facigly's Phone: (310).-1-17-7100 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group Of any)) No. Type Quantity WINbl. 13.Waste Codes <br /> a 1' UN1993,WASTE FLAMMABLE WASTE LIQUID,N.O.S.,(DIESEL, D001 D018 343 <br /> GASOLINE),3,PG II DM G <br /> s 2 <br /> Lo <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and.Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 *PROFILE#9B1:051817-04 DIESEL,GASOLINE* *APPROPRIATE <br /> PERSONAL PROTECTIVE EQUIPMENT 2 ) j r� C <br /> 15. GENERATOj'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cerlify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimizallon statement Identified In 40 CFR 262.27(a)(f I am a large quantity generator)or(b)(41 am a small quantity generator)is true, <br /> a QV.1100erofs PdnlWryl>e•.i N une S!grralure - l,lcn+.h Lay Year <br /> L' <br /> 16.1nserma5anaE Shipnlenl: ❑Import to U.S. ❑Export from U.S. Part of entrylexlt <br /> z Transporter signature(for exports onty): Date leaving U.S.: <br /> IX 17.Transporter Acknowledgment of Receipt of Materials <br /> Ei <br /> CW;Jt@cYUyDeti Na r Slgn.ur(i lyfonlh Day Yar <br /> �{. M z� <br /> Tiansporter2 Pnn yped Name Signaler Month Day Year <br /> tY <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑TypeEl ff ll j j <br /> Residue LJ Partial Rejection El Rejection <br /> llarlifml Reference Number <br /> 18b.Atla=la Facility(or Generator) U.S.ENA€D Nurnbor <br /> J <br /> U <br /> f acgrys Phone; <br /> Li3 18c.Signature of Nlernale FaGti6)(or Generator) Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Melford Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> _. 2. 3 4. <br /> 20.Designaled Facility Owner or Operator:Ceriificalion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prinled(Typed Name &gnalure Month Day Year <br /> EPA Fvrn870D•22(Rev.3-05) Previous ediiornsare obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />